Supportive care needs among older Mexican adults with metastatic cancer.

INTRODUCTION: Supportive care needs may vary according to age. The purpose of this research is to describe and compare supportive care needs between older adults with metastatic cancer (age ≥ 65 years) and their younger counterparts. MATERIALS AND METHODS: We conducted a retrospective secondary analysis of a cohort of patients with newly diagnosed metastatic solid tumors. Supportive care needs were assessed at baseline and at a three-month follow-up. Patients were divided into two groups (aged ≥65/<65 years). Differences in clinical characteristics and supportive care needs were compared utilizing descriptive statistics. Multivariate logistic regression models were employed to identify patient characteristics associated with specific supportive care needs. RESULTS: Between 2018 and 2022, 375 patients were enrolled. Median age was 66 years (interquartile range 19-94). At baseline, older adults had a higher number of supportive care needs (4.8 vs. 4.2, p = 0.01) and were at higher risk of malnutrition (75 vs. 65%, p = 0.05). Increasing age (odds ratio [OR] 1.02 (95% confidence interval [CI] 1.0-1.04, p = 0.03) and an estimated life expectancy <6 months (OR 3.0, 95%CI 1.5-6.1; p < 0.01) were associated with higher odds of malnutrition, while a higher educational level was associated with decreased odds (OR 0.68, 95%CI 0.5-0.8; p < 0.01). At three-month follow-up, older adults still had a higher number of supportive care needs (3.8 vs.2.6, p < 0.01) and were more likely to have fatigue (62 vs. 47%, p = 0.02). An estimated life expectancy of <6 months was associated with increased odds of fatigue (OR 3.0, 95%CI 1.5-6.3; p < 0.01). DISCUSSION: Older adults reported significantly more supportive care needs, particularly risk of malnutrition and fatigue. This information can help in the creation of supportive care services tailored to the needs of older individuals.

Urine biomarkers for Alzheimer's disease: A new opportunity for wastewater-based epidemiology?

While Alzheimer's disease (AD) diagnosis, management, and care have become priorities for healthcare providers and researcher's worldwide due to rapid population aging, epidemiologic surveillance efforts are currently limited by costly, invasive diagnostic procedures, particularly in low to middle income countries (LMIC). In recent years, wastewater-based epidemiology (WBE) has emerged as a promising tool for public health assessment through detection and quantification of specific biomarkers in wastewater, but applications for non-infectious diseases such as AD remain limited. This early review seeks to summarize AD-related biomarkers and urine and other peripheral biofluids and discuss their potential integration to WBE platforms to guide the first prospective efforts in the field. Promising results have been reported in clinical settings, indicating the potential of amyloid ß, tau, neural thread protein, long non-coding RNAs, oxidative stress markers and other dysregulated metabolites for AD diagnosis, but questions regarding their concentration and stability in wastewater and the correlation between clinical levels and sewage circulation must be addressed in future studies before comprehensive WBE systems can be developed.

Calidad de vida profesional de quienes laboran en cuidados paliativos y su relación con el autocuidado, la atención plena y el sentido de vida / Professional quality of life of palliative care staff and its relationship with selfcare, mindfulness and meaning of life

Introducción: La calidad de vida profesional (que incluye satisfacción y fatiga por compasión) y sus factores asociados, han sido poco explorados en cuidados paliativos (CP) en Latinoamérica. Objetivo: Determinar la calidad de vida profesional en CP y su relación con el autocuidado, la capacidad de atención plena y el sentido de vida. Método: Estudio observacional, de corte transversal. Participaron profesionales laborando en CP en Colombia. Se empleó el PROQOL para evaluar satisfacción por compasión (SC), Burnout y trauma secundario (TS), el PSCS para examinar autocuidado, el MAAS para examinar atención plena y la Escala dimensional de sentido de vida (EDSV). Se realizaron análisis descriptivos, correlacionales y de regresión múltiple. Resultados: participaron 108 profesionales. Edad promedio 38 años, 55% médicos, 73% mujeres, 32,4% reportaron elevada afectación del bienestar por la Covid-19. El 85% obtuvieron puntuaciones medias o altas en SC, el 75,9% en Burnout y el 81,5% en TS (con medianas de 42.5, 21 y 12, respectivamente). Hubo una correlación positiva y significativa entre PSCS, MAAS y EDSV con SC, pero negativa y significativa con Burnout y TS. En conjunto, la SC, el MAAS y el autocuidado social tuvieron un efecto predictivo negativo sobre los niveles de Burnout (R2=0,535). Conclusiones: Aunque la mayoría de participantes están satisfechos con su labor, los índices de Burnout y TS fueron elevados durante el período de pandemia. El en conjunto, la satisfacción por compasión, la atención plena y el autocuidado social predijeron niveles menores de Burnout, indicando potenciales vías de apoyo para quienes ejercen CP (AU)

Introduction. Professional quality of life (involving compassion satisfaction and compassion fatigue) and its related factors have been poorly explored in Palliative Care (PC). Objectives. To determine the professional quality of life of PC practitioners in Colombia and its relationship with self-care, mindfulness and meaning of life. Methods. Observational cross-sectional study. Practicing professionals of PC of Colombia were invited. Compassion Satisfaction (CS), Burnout, and Secondary Trauma (ST) were assessed using PROQOL; selfcare was examined using PSCS; MAAS was used to assess Mindfulness capacity, and the Dimensional Scale of sense of life (EDSV) was also employed. Descriptive correlational, and multiple regression analyses were performed. Results. One-hundred and eight participants participated; mean age of 38 years, 73% women, 32,4% indicated high impact on their wellbeing due to Covid-19; 85% of participants showed medium-high scores on CS, 75,9% on Burnout, and 81,5% on ST (median scores of 42.5, 21, and 12, respectively). Scores on PSCS, MAAS and EDSV positively and significantly correlated with CS, and were negatively and significantly related with Burnout and ST. Altogether, SC, MAAS and social selfcare had a negative predictive effect on Burnout levels (R2=0.538). Conclusion. Although most participants were satisfied with their jobs, scores on Burnout, and TS were high during the Pandemic. Together, compassion satisfaction, mindfulness and social selfcare were predictive of lower levels of Burnout, signaling potential lines of intervention for PC practitioners (AU)

CMC Strategies and Advanced Technologies for Vaccine Development to Boost Acceleration and Pandemic Preparedness.

This review reports on an overview of key enablers of acceleration/pandemic and preparedness, covering CMC strategies as well as technical innovations in vaccine development. Considerations are shared on implementation hurdles and opportunities to drive sustained acceleration for vaccine development and considers learnings from the COVID pandemic and direct experience in addressing unmet medical needs. These reflections focus on (i) the importance of a cross-disciplinary framework of technical expectations ranging from target antigen identification to launch and life-cycle management; (ii) the use of prior platform knowledge across similar or products/vaccine types; (iii) the implementation of innovation and digital tools for fast development and innovative control strategies.

Stress Induced Cortisol Release Depresses The Secretion of Testosterone in Patients With Type 2 Diabetes Mellitus.

Background: Both hormonal and genetic data reveal that the stress hormone cortisol and its regulating genes may affect the level of testosterone in humans. It is uncertain whether type 2 diabetes mellitus would manifest similarly. Furthermore, a genetic strategy to screen out the stress system genes that may contribute to testosterone decline in humans is less understood. Objectives: In this study, we aimed to elucidate the link between stress and testosterone levels, both hormonally and genetically. Method: This study comprised 37 individuals with type 2 diabetes mellitus and 50 healthy individuals. For the analysis of hormones and the targeted genes, we used the RIA system and bioinformatics expertise. Results: The patients had significantly elevated cortisol and lower testosterone readings, according to data from hormonal analyses. The bioinformatics approach reveals that SHBG was intracellularly suppressed by 2 defined stress system genes: FKB5 and CYP17. TCF4/TCF8, ATRX, and AR in skeletal muscle were inversely related to stress system genes. Furthermore, all testosterone regulated genes were positively linked with SHBG in the current study. A strong relationship between GNAS and PKA with CYP17 and FKBP5 reveals that the Gαs-cAMP/PKA signaling pathway may be one of the regulatory pathways through which the suppression of testosterone system genes happens. In conclusion, this study demonstrated that beyond stress, the key stress system genes might affect cortisol levels, which in turn affect testosterone figures via the Gαs-cAMP/PKA signaling pathway.

Comparative study of brain damage and oxidative stress using two animal models of the shaken baby syndrome.

The objective was compare the morphological damages in brain and to evaluate the participation of oxidative stress, using two animal models of shaken baby syndrome (SBS). Five-day-old Wistar rats were used to develop two models of SBS as follows: Gyrotwister (GT) group was subjected to low intensity, high duration rotating movements and Ratshaker (RS) group made to undergo high intensity, low duration anteroposterior movements. Both groups presented respiratory distress, weight loss and shorter stature compared with the control group. In addition, involuntary movements occurred in both experimental models. Hemorrhage was observed in 10 % of the GT group and in 40 % of the RS group. This last group experienced lesser weight gain at 30 days. Glutathione decreased by 25.7 % (GT) and 59.96 (RT). Cell data analysis revealed the presence of crenate and pyknotic cells, characterized by apparent absence of nucleus and nucleolus as well as vacuolation in the GT group. In the RS group, there were a high number of angular, pyknotic and shrunken cells, and a lot of vacuolization. The severity of the brain damage can be related to the magnitude of biochemical modifications, specifically, those related to the production of reactive oxygen or nitrogen species, oxidative stress, oxidative damage.

Inflammatory Process and Immune System in Major Depressive Disorder.

Major depressive disorder (MDD) is one of the most common psychiatric illnesses in the general population. In mental disorders, the activation of inflammatory pathways in the brain is a major producer of excitotoxicity and an inducer of oxidative stress. The occurrence of these 2 events is partly responsible for the neuronal damage inherent in patients with mental disorders. In the case of MDD, the release of hormone and increase in pro-inflammatory cytokines in plasma and indicators of oxidative stress have been identified as consequences of this event. The most important affectations in patients with MDD are changes in their cognitive and executive functions due to brain inflammation. Hence, these biomarkers can serve as diagnostic and severity classification tools and treatment. In this work, we described the communication pathway between the immune and neuroendocrine systems in MDD and suggested possible therapeutic options for the disease.

Tuberculosis in Children in a Pediatric Hospital in Mexico.

Tuberculosis (TB) remains a global problem and a diagnostic challenge, especially in pediatrics. The aim of this study was to describe the clinical, microbiological, radiological, and histopathological data of TB in children. A 7-year retrospective and descriptive cohort study that included 127 patients under 18 years of age with diagnosis of active TB was conducted from 2011 to 2018 in a pediatric hospital. Tuberculosis was microbiologically confirmed using Ziehl-Neelsen (ZN) staining, culture or polymerase chain reaction (PCR) in a total of 94 (74%) cases. Thirty-three cases were defined as probable TB based on tuberculin skin test result and epidemiological evaluation. The TB forms found were lymph node (39.3%), bone (15.7%), lung (13.6%), and meningeal TB (8.6%). The most common symptoms were fever (48.8%) and adenopathy (45.6%). History of contact was established in 34.6%. Positive ZN staining (sensitivity 30%) and culture (sensitivity 37%) were found in 29% and 37.7% of subjects, respectively. About 64.5% depicted abnormal chest X-ray. Xpert MTB/RIF® (PCR) was positive in 9.4% and biopsy was compatible in 52.7% of these samples. It is fundamental to have laboratory and epidemiological evaluation that support the diagnosis of the disease in children and thus, define its management; since, in most cases, early microbiologic confirmation is lacking.

Providing Supportive and Palliative Care Using Telemedicine for Patients with Advanced Cancer During the COVID-19 Pandemic in Mexico.

COVID-19 has overwhelmed the capacity of health care systems, limiting access to supportive and palliative care for patients with advanced cancer. Telemedicine has emerged as a tool to provide care continuity to patients while limiting the risk of contagion. However, implementing telemedicine in resource-limited settings is challenging. We report the results of a multidisciplinary patient-navigator-led telemedicine supportive care program in Mexico City. One-hundred sixty-three telemedicine interventions were provided to 45 patients (median age 68, 57% female). A quarter of the patients had less than or equal to elementary school education, and 15% lived in a rural area. The most common interventions were psychological care (33%), pain and symptom control (25%), and nutritional counseling (13%). Half of the interventions were provided by video conferencing. The most common patient-reported barrier was limited experience using communication technology. Our results demonstrate the feasibility of providing supportive and palliative care interventions using telemedicine in resource-limited settings.

Differential chromatin accessibility landscape reveals structural and functional features of the allopolyploid wheat chromosomes.

BACKGROUND: Our understanding of how the complexity of the wheat genome influences the distribution of chromatin states along the homoeologous chromosomes is limited. Using a differential nuclease sensitivity assay, we investigate the chromatin states of the coding and repetitive regions of the allopolyploid wheat genome. RESULTS: Although open chromatin is found to be significantly enriched around genes, the majority of MNase-sensitive regions are located within transposable elements (TEs). Chromatin of the smaller D genome is more accessible than that of the larger A and B genomes. Chromatin states of different TEs vary among families and are influenced by the TEs' chromosomal position and proximity to genes. While the chromatin accessibility of genes is influenced by proximity to TEs, and not by their position on the chromosomes, we observe a negative chromatin accessibility gradient along the telomere-centromere axis in the intergenic regions, positively correlated with the distance between genes. Both gene expression levels and homoeologous gene expression bias are correlated with chromatin accessibility in promoter regions. The differential nuclease sensitivity assay accurately predicts previously detected centromere locations. SNPs located within more accessible chromatin explain a higher proportion of genetic variance for a number of agronomic traits than SNPs located within more closed chromatin. CONCLUSIONS: Chromatin states in the wheat genome are shaped by the interplay of repetitive and gene-encoding regions that are predictive of the functional and structural organization of chromosomes, providing a powerful framework for detecting genomic features involved in gene regulation and prioritizing genomic variation to explain phenotypes.

Variation in the AvrSr35 gene determines Sr35 resistance against wheat stem rust race Ug99.

Puccinia graminis f. sp. tritici (Pgt) causes wheat stem rust, a devastating fungal disease. The Sr35 resistance gene confers immunity against this pathogen's most virulent races, including Ug99. We used comparative whole-genome sequencing of chemically mutagenized and natural Pgt isolates to identify a fungal gene named AvrSr35 that is required for Sr35 avirulence. The AvrSr35 gene encodes a secreted protein capable of interacting with Sr35 and triggering the immune response. We show that the origin of Pgt isolates virulent on Sr35 is associated with the nonfunctionalization of the AvrSr35 gene by the insertion of a mobile element. The discovery of AvrSr35 provides a new tool for Pgt surveillance, identification of host susceptibility targets, and characterization of the molecular determinants of immunity in wheat.

Natural Steroids and Androgen Antagonists used as Neuroprotection in Common Neurological Disorders.

BACKGROUND & OBJECTIVE: Multiple classes of natural products, such as antiandrogens or steroids have been used as antioxidants and anti-inflammatory treatments in neurodegenerative diseases. This paper aims to review current knowledge on these substances and their possible relationship with free radicals as an alternative therapy and prevention of common neurological disorders. An exhaustive review of the neurochemical mechanisms of these substances in the central nervous system of humans and animal models is yet to be undertaken in the literature, particularly regarding their importance and increasing use. CONCLUSION: Androgen receptor antagonists act in a different way that may underlie the benefits of natural products, with the expectation that in adults, neurological disorders would respond to natural antiandrogens. We hope that this work would provide valuable insight into the protective and therapeutic roles for natural antiandrogens and steroids in common neurological disorders.

Mechanisms involved in the development of diabetic retinopathy induced by oxidative stress.

BACKGROUND: Diabetic retinopathy (DR) is one of the main complications in patients with diabetes and has been the leading cause of visual loss since 1990. Oxidative stress is a biological process resulting from excessive production of reactive oxygen species (ROS). This process contributes to the development of many diseases and disease complications. ROS interact with various cellular components to induce cell injury. Fortunately, there is an antioxidan t system that protects organisms against ROS. Indeed, when ROS exceed antioxidant capacity, the resulting cell injury can cause diverse physiological and pathological changes that could lead to a disease like DR. OBJECTIVE: This paper reviews the possible mechanisms of common and novel biomarkers involved in the development of DR and explores how these biomarkers could be used to monitor the damage induced by oxidative stress in DR, which is a significant complication in people with diabetes. CONCLUSION: The poor control of glucemy in pacients with DB has been shown contribute to the development of complications in eyes as DR.

Pediatric Invasive Pneumococcal Disease in Guatemala City: Importance of Serotype 2.

INTRODUCTION: To inform estimations of the potential impact of recently introduced pneumococcal conjugate vaccine (PCV), we report results of 11 years of pre-PCV surveillance for invasive pneumococcal disease (IPD) among children in Guatemala City. METHODS: Cases of IPD in children younger than 5 years were identified by active surveillance at 3 referral hospitals in Guatemala City from October 1996 through 2007. Clinical and demographic data were obtained, and isolates of Streptococcus pneumoniae from normally sterile sites were serotyped using latex agglutination and confirmed by Quellung reaction. RESULTS: Four hundred fifty-two cases of IPD were identified with a case fatality rate of 21%. Meningitis was the most common cause of death (77% of all deaths) and occurred more often in infancy (median age 5 months) than other clinical syndromes. Of the 137 isolates serotyped, type 1 (26 cases, 17%), type 2 (25 cases, 16%) and type 5 (18 cases, 12%) were the most common. Serotype 2 was associated with a higher case fatality rate (28%), higher rate of meningitis (68%) and occurred in younger infants (median age, 3.5 months) than other common serotypes. Recently introduced PCV13 includes 73% of observed serotypes in the study. CONCLUSION: Infants with IPD presented at a young age. Serotype 2, rarely reported as a significant cause of IPD and not included in available PCVs, was a common cause of disease in this population. PCV13 introduction in Guatemala, begun in 2013, may not have as great an impact in disease reduction as has been observed in other countries.

Condiciones de vida y trabajo de familiascampesinas agricultoras de Marinilla, un puebloagrario del oriente Antioqueño, Colombia, 2011 / Living and working conditions of peasant farmers and their families in Marinilla, Antioquia, Colombia, 2011

Objetivo: Describir las condiciones socioeconómicas, desalud, higiénico sanitarias y de trabajo en familias agricultorasdel municipio de Marinilla-Antioquia. Metodología: Estudiodescriptivo transversal de una muestra no probabilística de83 familias. El objetivo se logró mediante la aplicación de uncuestionario y la observación de las condiciones higiénicoûsanitarias de las viviendas en nueve veredas. Resultados: Laagricultura fue de tipo familiar, con auto-explotación del predioque no generó ingresos suficientes para subsistir (73,8%), poruso de herramientas manuales (99%) y porque el único equipodel que disponían (79,1%) fue el de fumigación. Aunque hacubierto el ciclo vital y generacional de sus integrantes, solo17,7% desea que sus hijos continúen la tradición agrícola. Parala mayoría el trabajo se realizó en jornadas de 8 o más horas,6 o 7 días por semana, sin vacaciones, con accidentalidaddel 26,2%, uso continuo de plaguicidas de moderada y altapeligrosidad por 25,9 años en promedio y con escasa (3,9%)protección social para incapacidad, invalidez, vejez y muerte.Sin embargo se identificó un aumento de propiedad sobre latierra (65%), de la afiliación al sistema subsidiado de salud(96,3%), del nivel de alfabetismo aunque la formaciónsuperior técnica o profesional fue del 3,2% y de accesoal sistema de abastecimiento de agua comunal (96,4%).Conclusión: la agricultura continúa determinando la vidadel campo en Marinilla y es poco esperanzadora para lasfuturas generaciones, los líderes regionales deberán actuarefectivamente si se quiere preservar el distrito Agrario delOriente Antioqueño...

Objective: to describe the socio-economic, health, hygienic,sanitary and working conditions of farming families livingin the municipality of Marinilla, Antioquia. Methodology:a cross-sectional descriptive study conducted with a nonrandomsample of 83 families. The goal was reached byapplying a questionnaire and observing the hygienic andsanitary conditions of the houses in nine villages. Results: thetype of agriculture observed was family farming. The farmingactivities were performed in the participantsÆ property and didnot generate enough income to survive (73.8%). Similarly,these activities were performed using hand tools (99%) andthe only equipment available were fumigation pumps (79.1%). Although agriculture has covered the life and generationalcycles of the family members, only 17.7% of them want theirchildren to carry on with the agricultural tradition. Work wasperformed in shifts of 8 or more hours, 6 or 7 days a week, withno holidays, with an accident rate of 26.2%, with continuoususe of pesticides of moderate to high hazard for 25.9 yearson average and with low (3.9%) social protection coveringincapacity, disability, old age and death. However, this studyidentified increases in land ownership (65%), affiliation to thesubsidized health system (96.3%), level of literacy -althoughthe level of technical or professional higher education was3.2%- and access to the communal water supply (96.4%).Conclusion: agriculture continues to play a key role in theMarinilla country life, and there is little hope for the cominggenerations; regional leaders must act effectively if they wantto preserve the agricultural district of Eastern Antioquia...

Infección por Bordetella pertussis en contactos domiciliarios de casos de tosferina en el suroriente de la ciudad de Cali, Colombia 2006-2007 / Bordetella pertussis infection in household contacts of cases of pertussis in the southeast zone of the city of Cali, Colombia, 2006-2007

Introducción: Bordetella pertussis causa tos ferina o tos convulsiva, enfermedad contagiosa e inmunoprevenible, una de las primeras 10 causas de muerte entre niños menores de 1 año, al no estar completamente inmunizados. Se considera reemergente en varios países, con altas tasas de complicaciones y hospitalizaciones.Objetivo: conocer la proporción de infección por B. pertussis, entre casos sospechosos de tosferina y sus contactos domiciliarios entre niños del suroriente de Cali, área geográfica con mayor demanda de consulta por esta infección.Metodología: Estudio descriptivo de corte transversal. Se tomaron datos epidemiológicos y muestras nasofaringeas a 24 casos sospechosos y sus 109 contactos domiciliarios. Las muestras se analizaron por la reacción en cadena de la polimerasa en tiempo real (Q-PCR) y por cultivo.Resultados: La proporción de positividad entre los casos por la técnica de Q-PCR fue de 50% (12/24) y 40% por la técnica de cultivo (8/20), con buena concordancia entre las dos técnicas (Kappa 0.61). En cuanto a los contactos, 30.3% (33/109) (IC 95%: 21.8%-39.8%) resultaron positivos. Los contactos hermanos (7/15) y las madres (7/22) presentaron la mayor proporción de positividad. En cuanto a la edad, 60% con 4 años (3/5) y 50% en el grupo de 45- 64 años. No se encontraron diferencias significativas entre la presencia o ausencia de síntomas y la presencia de infección por B. pertussis, excepto en la presencia de flujo nasal (moquiadera) (27%) y tos (36%) durante el último mes.Conclusiones: El estudio confirma la alta prevalencia de infección asintomática por B. pertussis entre contactos domiciliarios de niños con sintomatología de tosferina y la transmisión domiciliaria de la misma. En Cali es necesario revisar la efectividad de las estrategias de control implementadas y la utilización de un esquema de vacunación que no cubre a la población adolescente y adulta como control del foco de infección.

Introduction: Bordetella pertussis causes whooping cough or convulsive cough, a contagious and immune-preventable disease. It is one of the 10 leading causes of death among children younger than one year of age, when not completely immunized. It is considered reemerging in several countries, with high rates of complications and hospitalizations.Methodology: This is a cross-sectional descriptive study. Epidemiological data and nasopharyngeal samples were taken from 24 suspected cases and from their 109 household contacts. The samples were analyzed via real-time polymerase chain reaction (Q-PCR) and through culture.Results: The proportion of positivity among the cases via the Q-PCR technique was at 50% (12/24) and at 40% via the culture technique (8/20), with good agreement between both techniques (Kappa 0.61). Regarding the household contacts, 30.3% (33/109) (CI 95%: 21.8%-39.8%) tested positive. The sibling contacts (7/15) and the mothers (7/22) presented the greatest proportion of positivity. Regarding age, 60% were 4 years of age (3/5) and 50% were in the group comprised of individuals 45 to 64 years of age. No significant differences were found among the presence or absence of symptoms and the presence of B. pertussis infection, except for the presence of nasal secretions (runny nose) (27%) and coughing (36%) during the last month.Conclusions: The study confirms the high prevalence of asymptomatic infection by B. pertussis among household contacts of children with whooping cough symptomatology and its household transmission. In Cali, health authorities need to review the effectiveness of implemented control strategies and the use of a vaccination scheme that does not cover adolescent and adult populations as a focus of infection control.

Thrombocytopenia and platelet hypoaggregation induced by Bothrops asper snake venom. Toxins involved and their contribution to metalloproteinase-induced pulmonary hemorrhage.

Thrombocytopenia and platelet dysfunction occur in patients bitten by Bothrops sp snakes in Latin America. An experimental model was developed in mice to study the effects of B. asper venom in platelet numbers and function. Intravenous administration of this venom induces rapid and prominent thrombocytopenia and ex vivo platelet hypoaggregation. The drop in platelet numbers was primarily due to aspercetin, a protein of the C-type lectin family which induces von Willebrand factor-mediated platelet aggregation/agglutination. In addition, the effect of class P-III hemorrhagic metalloproteinases on the microvessel wall also contributes to thrombocytopenia since jararhagin, a P-III metalloproteinase, reduced platelet counts. Hypoaggregation was associated with the action of procoagulant and defibrin(ogen)ating proteinases jararacussin-I (a thrombin-like serine proteinase) and basparin A (a prothrombin activating metalloproteinase). At the doses which induced hypoaggregation, these enzymes caused defibrin(ogen)ation, increments in fibrin(ogen) degradation products and D-dimer and prolongation of the bleeding time. Incubation of B. asper venom with batimastat and alpha2-macroglobulin abrogated the hypoaggregating activity, confirming the role of venom proteinases in this effect. Neither aspercetin nor the defibrin(ogen)ating and hypoaggregating components induced hemorrhage upon intravenous injection. However, aspercetin, but not the thrombin-like or the prothrombin-activating proteinases, potentiated the hemorrhagic activity of two hemorrhagic metalloproteinases in the lungs.

Meningitis and pneumonia in Guatemalan children: the importance of Haemophilus influenzae type b and Streptococcus pneumoniae

OBJECTIVE: To determine the epidemiology of Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae invasive infections in hospitalized Guatemalan children. This is an important issue since Hib vaccine has not been incorporated into the routine immunization program in Guatemala and information from hospital records in 1995 indicated a low incidence of Hib and S. pneumoniae as causes of meningitis and invasive infections. METHODS: Children who were hospitalized in Guatemala City with clinical signs compatible with bacterial infections were evaluated for evidence of Hib or S. pneumoniae infection. Normally sterile body fluids were cultured, and antigen detection was performed on cerebrospinal fluid (CSF) and pleural fluid. RESULTS: Of 1 203 children 1-59 months of age hospitalized over a 28-month period, 725 of them (60.3 percent) had a primary diagnosis of pneumonia, 357 (29.7 percent) of meningitis, 60 (5.0 percent) of cellulitis, and 61 (5.1 percent) of sepsis and other conditions. Hib was identified in 20.0 percent of children with meningitis and S. pneumoniae in 12.9 percent. The average annual incidence of Hib meningitis was 13.8 cases per 100 000 children under 5 years of age, and 32.4 percent of meningitides caused by Hib and 58.7 percent of S. pneumoniae meningitides occurred prior to 6 months of age. Case fatality rates were 14.1 percent, 37.0 percent, and 18.0 percent, respectively, for children with Hib, S. pneumoniae, and culture-negative and antigen-negative meningitis. Prior antibiotic therapy was common and was associated with significant reductions in CSF-culture-positive results for children with other evidence of Hib or S. pneumoniae meningitis. CONCLUSIONS: Improvements in case detection, culture methods, and latex agglutination for antigen detection in CSF resulted in identification of Hib and S. pneumoniae as important causes of severe disease in Guatemalan children. Using a cutoff of > 10 white blood cells per cubic millimeter in CSF would improve the sensitivity for detection of bacterial meningitis and help estimate the burden of bacterial meningitis in Guatemala and other developing countries.

Meningitis and pneumonia in Guatemalan children: the importance of Haemophilus influenzae type b and Streptococcus pneumoniae.

OBJECTIVE: To determine the epidemiology of Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae invasive infections in hospitalized Guatemalan children. This is an important issue since Hib vaccine has not been incorporated into the routine immunization program in Guatemala and information from hospital records in 1995 indicated a low incidence of Hib and S. pneumoniae as causes of meningitis and invasive infections. METHODS: Children who were hospitalized in Guatemala City with clinical signs compatible with bacterial infections were evaluated for evidence of Hib or S. pneumoniae infection. Normally sterile body fluids were cultured, and antigen detection was performed on cerebrospinal fluid (CSF) and pleural fluid. RESULTS: Of 1 203 children 1-59 months of age hospitalized over a 28-month period, 725 of them (60.3%) had a primary diagnosis of pneumonia, 357 (29.7%) of meningitis, 60 (5.0%) of cellulitis, and 61 (5.1%) of sepsis and other conditions. Hib was identified in 20.0% of children with meningitis and S. pneumoniae in 12.9%. The average annual incidence of Hib meningitis was 13.8 cases per 100 000 children under 5 years of age, and 32.4% of meningitides caused by Hib and 58.7% of S. pneumoniae meningitides occurred prior to 6 months of age. Case fatality rates were 14.1%, 37.0%, and 18.0%, respectively, for children with Hib, S. pneumoniae, and culture-negative and antigen-negative meningitis. Prior antibiotic therapy was common and was associated with significant reductions in CSF-culture-positive results for children with other evidence of Hib or S. pneumoniae meningitis. CONCLUSIONS: Improvements in case detection, culture methods, and latex agglutination for antigen detection in CSF resulted in identification of Hib and S. pneumoniae as important causes of severe disease in Guatemalan children. Using a cutoff of > 10 white blood cells per cubic millimeter in CSF would improve the sensitivity for detection of bacterial meningitis and help estimate the burden of bacterial meningitis in Guatemala and other developing countries.